In exhibitionism, the sexually arousing fantasies involve exposing the genitals to an unsuspecting stranger. Almost always, this involves a heterosexual male exposing his penis to an adolescent or adult woman. However, this disorder may be underreported in women. There is no attempt at further sexual activity with the target female. Erection or masturbation may occur during the act, or the episode may be recalled later for sexual arousal and masturbation. Usually the fantasy focuses on the reaction of the female (surprise, shock, disgust, or interest), but there may be other fantasies of the female becoming sexually aroused or approaching the male for sexual activity.

In some cases there may be rape fantasies, which should be diagnosed as a paraphilia not otherwise specified (rapism or raptophilia). Exposure to children may be indicative of pedophilia rather than exhibitionism. In both of these examples, the exposure is a prelude in fantasy to other sexual activities, which the individual has not acted out, rather than being the goal and end point of sexual fantasy and activity.

Exhibitionism tends to be highly compulsive in younger men, with frequent episodes starting in the teens, but then decreasing in severity in older men.